Upcoming Fee Schedule Changes, Including Highmark’s Annual Adjustment

Effective July 1, 2026, Highmark will make its annual update to its standard professional fee schedule and pricing methodology across all regions.

Standard Professional Commercial Fee Schedules

Effective July 1, 2026, Highmark will make its annual update to standard professional Commercial fee schedules for DE¹, NY, PA, and WV.

This change does not affect Highmark’s Medicaid plans or any value-based fee schedule adjustments. The annual update is part of Highmark’s continued effort to align with industry standard values and remains non-negotiable for contracted providers.

The yearly review of our standard professional fee schedule and pricing methodology enables Highmark to:

• Update our fee allowances based on industry research by leveraging different sources and data points, including changes the Centers for Medicare and Medicaid Services (CMS) made to the 2026 Medicare Physician Fee Schedule.
• Continue to bring our fee schedules in closer alignment with Highmark’s Value-Based Reimbursement strategies through uniform standard fees.
• Make changes that reflect current factors and trends in the marketplace.

You can view the updated standard professional fee schedules within Availity Essentials beginning June 1, 2026.

How to Review Fee Schedules

You can view the updated fee schedules within Availity a month prior to their implementation dates. Once you log into Availity, select Claims and Payments from the task bar and then Fee Schedule Listing from the right side. You can also access fee schedules by going to Highmark’s Payer Spaces in Availity and selecting Provider Resource Center (PRC) under Applications. Once you arrive at the PRC, select Claims > Reimbursement Resources > Fee Schedule Information.

¹Any changes to the Commercial standard professional fee schedule and pricing methodology will comply with 18 Del. Code §§ 3342B and 3556A.